Paleo Breakfast Casserole Egg Bake

This content originally appeared on Low Carb Yum. Republished with permission.

This super flavorful breakfast casserole is one of my favorite ways to enjoy eggs.

For a long time, my go-to was an omelette filled with cheese and vegetables. However, I discovered that dairy causes inflammation for me, so I’ve been trying to eat less cheese.

Simply eliminating the cheese from my omelette felt unsatisfying, though. I needed a new favorite breakfast. And that’s when the idea of a paleo breakfast casserole came to mind!

This is the kind of hearty breakfast that keeps you full and happy for hours. The sausage gives it amazing flavor, plus it’s packed with veggies. To be honest, I didn’t even miss the cheese in this dish.

It’s also a fantastic way to meal prep for the week. If you’ve been searching for healthy, budget-friendly meal prep ideas, this paleo egg casserole is the perfect solution. It will keep well in the fridge for a week, or you can freeze slices for later!

Easy Paleo Breakfast Casserole with Sausage

An easy paleo breakfast casserole with sausage and vegetables. Make ahead on the weekend for a full week of low-carb breakfasts or freeze some for later.

  • 1 tablespoon olive oil (or avocado oil)
  • 1 pound nitrate-free paleo sausage ( no casing (or other ground meat))
  • 2 cloves garlic (minced)
  • 1/2 teaspoon dry minced onion flakes (optional)
  • 3 cups yellow summer squash (cubed)
  • 12 ounces broccoli (chopped)
  • 12 eggs
  • 1/2 cup almond milk (or coconut milk)
  • 1/4 teaspoon sea salt
  • 1/8 teaspoon pepper
  1. Cook sausage, garlic, and onion flakes (if using) in oil over medium-high heat until sausage is browned.

  2. Add squash and broccoli and cook until vegetables are tender.
  3. Spread sausage and vegetable mix into a 9×13 casserole dish.
  4. In a medium bowl, whisk together eggs, almond or coconut milk, salt, and pepper.

  5. Pour egg mixture over sausage mix.
  6. Bake at 375°F for 30-35 minutes or until eggs are set and the top has started to brown.

Feel free to change up the recipe by using different vegetables, different meat, or adding in cheese (for non-Paleo).

Paleo Breakfast Casserole Egg Bake Recipe

Source: diabetesdaily.com

On Falling in Love and Climbing Mountains with Diabetes

This content originally appeared on Beyond Type 1. Republished with permission.

By Siobhan Casey

The Catalyst

“What if you got ill, what would you do then? Who would you call? How would you get home? Why don’t you start with a smaller trip?”

While my counselor posed reasonable questions, my answers convinced me, after twelve years of self-doubt and physical struggle that no, my identity was not “Type 1 Diabetic” or “Thirty-Two Year Old, Unmarried Woman.” Instead it was introspective adventurer, writer, childcare provider, and admirer of all things beautiful.

So that Friday, I compiled well-marked maps and packed my bags for the next five days. They overflowed with insulin pens, needle tops, cliff bars, glucagon pens, bags of Swedish Fish, bottled water, continuous glucose meters, glucose gel, old fashioned glucose meters, test strips, a hiking bag… As most traveling type 1s know, the list is far too long to enumerate. But I woke up in the spring of 2019 with the desire not just to survive and be helpful to others, but to head south and climb a great height. My destination: the Blue Ridge Mountains. This was no impulse. No, this was a conviction.

The Journey Begins

My palms were sweating as I set out on the scenic route, taking back roads in lieu of the more efficient highways. As with any good trip, nothing went quite as planned. For one thing, I got lost on my second day in Virginia, and my phone picked up no bars. But as soon as I found my way to a safe trail, I felt at home among the bugs and canopies of trees. Truthfully, I felt much less alone, in solitude and cloaked in Shenandoah National Park’s shades of blue, than I did among most people.

Siobhan Casey

Image source: Beyond Type 1

After meandering through and taking many breaks to eat the glucose and lunch I had packed, I found my way back to the main road. I stopped at each overlook to spread my arms and become a part of the staggering landscape. When I arrived back home, something small but essential shifted inside of me. I felt different, lighter, and more confident. I began to take my bike on longer, solo trips through the park. And I began to entertain the idea that my next trip would be far better with a companion. But I hesitated because my romantic relationships over the past decade had been fraught with oversharing or hiding how much I struggled with type 1 diabetes (T1D).

Things changed on a rainy spring evening. I decided to meet Roy mostly because he seemed like he knew something I didn’t, smiling and sipping out of a coconut in the photo in his dating profile. On the phone, we both liked to think and laugh in equal amounts and we loved the same Indie band and the same eccentric meditation guru. When I stepped through the door of the bar, I caught sight of him before he saw me. His dark hair fell to one side of his thoughtful face and unlike most people sitting on their own, he wasn’t scrolling through his phone but looking at the world around him. We hit it off, and in typical fashion, I didn’t trust it one bit.

The Rare Type

For one thing, he seemed like an impossible burger of a person! He was completing a fellowship in Cardiology and had very little ego. He worked long hours caring for patients in heart failure but rarely became exasperated. He played music, could write like a boss, and genuinely appreciated my varied pursuits of art and childcare. He was honest without being hurtful. I didn’t trust how beautiful this could become and so by the end of the first month of dating, I compiled mental notes of any small signs that he couldn’t “handle” my diabetes. It was a difficult task because he never once judged how I managed my numbers. Instead, he wondered aloud how I functioned on so little sleep.

By that August, he acknowledged that type 1 diabetes was nowhere nearly as straightforward to manage as he had previously thought. But he remained undeterred, and we took a week-long trip to the west coast, traveling between San Francisco and Monterey, stopping in solitude and solidarity to watch the Pacific roll in between coves and cliffs along Big Sur. He often said, “I don’t think of you as a sick person, you know…” and this assertion aligned with my own stubborn belief that in spite of the relentless nature of type 1, I could do so much with my life. As it turned out, I woke each day before he did, more than ready to take on Highway 101 and hike the heights of Pfieffer State Park, the trip I had always dreamed of making.

As type 1s, most of us wax grateful for strangers who help when we are having a low sugar in a public place. But in a relationship, what counts is not the fact that someone brings you juice. It’s that they do it, as Roy still does, at five in the morning three days in a row without any outward irritation. And that they genuinely believe you can do most things for yourself. They treat you as strong as you actually are inside but understand when you are worn down and could use a hand. Looking back, the first month together was a mountain of growing pains for me, of learning that, yes, this person has existed in the world this whole time and even if my pancreas is defunct, I am not. This love has been both as attainable and as rare as climbing the side of the Blue Ridge mountains with insulin on ice in my backpack before heading home – the journey never easy but always good.

Source: diabetesdaily.com

Traveling Abroad with Diabetes: Have Your Dolce and Eat It Too!

This content originally appeared on diaTribe. Republished with permission.

By Maria Horner

Maria shares her experiences and strategies for managing blood sugar levels while studying abroad

Like many young adults, I love to travel and will take any excuse to do so. Going into college, I knew that I wanted to study abroad; the moment I learned about my university’s semester program at their Rome campus, I was ready to go. However, traveling with diabetes isn’t always easy. The longer the trip, the more complicated it can be, and especially a trip to Italy, a country known for all of its carbohydrates!

What’s someone with diabetes to do about managing their diabetes while living in Italy?

Preparation is key!

One of the most important things I did to ensure my trip went well was put a lot of time into preparation. This means figuring out the quantity of diabetes supplies you’ll need, ordering them in advance, and finding space to pack it all. On my blog, I created a handy spreadsheet that helps you calculate exactly how much of each item you’ll need. You should start refilling your prescriptions as frequently as possible months before you travel, to make sure you stockpile enough supplies to last the whole trip. When I was preparing to go to Italy, my insurance only allowed me to order three months of supplies at one time, so I had to wait a few weeks before refilling my prescription. If you’re short on time, ask your healthcare professional if they can help you order extra supplies.

Preparation also means making back-up plans in case anything goes wrong, like talking through solutions to possible challenges. I have a great team of people that support me at home, including my parents, friends, and healthcare professionals, so before I left, I made sure I had several ways to contact them while abroad. Once I arrived in Rome, my host family, my friends, and the staff at my school became the people who could help me if I needed assistance.

Here are some things to talk about with your support team before you travel:

  • If I run out of a diabetes supply, what will I do? Can I get this supply abroad? Is having it shipped to me an option, considering what can be sent through the mail, what is allowed through customs, and the reliability of the mail system?
  • If I need to see a doctor or go to the hospital, can I find English-speaking doctors? Where is the closest hospital?
  • How does insurance work? Do I need to get special insurance while I am abroad?
  • How can I get in contact with my doctor? Can someone from my support team contact my doctor if I can’t?

Here’s a little story about how back-up supplies and my support team saved the day while I was in Rome:

About halfway through my semester, I was returning from Venice on an overnight trip and I arrived back in Rome early in the morning. I must have been sleep deprived, because I left my phone on the train! To anyone else, that would be very frustrating but manageable; most of the things people use their phones for, like email and messages, can be done on a computer. For me, it felt like a disaster, because my Dexcom G5 continuous glucose monitor (CGM) was tied to my phone. I love being able to check my blood sugar with just a glance at my phone, but without my phone, I couldn’t use my CGM. Because I’m used to constantly knowing my blood sugar, not having readings for an extended period of time was hard. Long story short, it was two days before I could get my phone back, and only with help from my support team in Rome. Thankfully, I had plenty of test strips and a blood glucose meter (BGM), so my back-up supplies came to the rescue.

Enjoy new foods, but do so in moderation.

After all my preparation, living in Rome still brought different challenges my way. Even though I wanted to experience all that Rome had to offer, I still had to keep blood sugar management in the back of my mind, especially during mealtime. Italian cuisine is full of carb-heavy foods, from pastries for breakfast to sandwiches, pizza, and pasta for lunch and dinner. Unfortunately, all these unknown carbs can make it hard to keep one’s blood sugar in range.

I didn’t want to deny myself all of the delicious, yet carb-rich, Italian foods. But I also didn’t want to drive my blood sugars out of my target range. I found that my best option was to eat these foods in moderation (just one or two bites), and fill myself up with delicious lower carb options, like vegetables and meat.

To prepare for a meal that may contain many carbs, make sure to dose extra insulin before the meal. If you end up eating more carbs than expected (which can easily happen with Italian food), the sooner you’re able to dose additional insulin – even if it means stopping in the middle of the meal to take insulin – the more quickly your blood sugars will respond.

Do some research and know what to order at restaurants.

When eating out at a restaurant, a good tactic is to order a meat, seafood, or vegetable-based dish as your main entree. Before you’re faced with ordering low-carb food in a foreign country, it’s helpful to know what you can expect from a local menu. Here’s what I learned in Italy:

  • Italian meals consist of several courses, including antipasto (appetizer), primi (the first course, typically pasta), secondi (the second course, usually meat or seafood), contorni (a side dish, usually a vegetable), and dolci (dessert).
  • Most people order either a primi or secondi as their main dish.
  • You can find the best low-carb options in the antipasti, secondi, or contorni sections of the menu.
  • If you have diabetes, ignore the primi section – it won’t be helpful for keeping your blood sugars in range.

One more tip: when you’re not sure what something is on the menu, it never hurts to ask the server or look up a picture online. This was important for me in Italy, since some of the meat dishes are breaded. I’ve included a list of my favorite low-carb Italian orders at the end of this article.

Share food with friends and family!

If you don’t want to miss out on experiencing all the pizza and pasta, get your friends to help you out. If they order a high-carb dish, ask if you can trade a few bites of your food for theirs – that way, you get to taste some pizza or pasta, while still keeping your meal low-carb. The same thing can apply to desserts, like gelato: ask a friend for a few bites, or offer to split one.

No matter what you decide to eat, just make sure you watch your blood sugars carefully, especially when trying new foods and guessing on insulin doses. Don’t let your diabetes stop you from exploring all the wonders of a new cuisine and culture, but also, don’t let impulsive food choices throw your blood sugars off. That balance can be hard to find, but do the best you can and enjoy the experience. Mangia bene (eat well)!

For more details, tips, and advice on studying abroad with diabetes, visit my blog, Winging It.

Here are some of my favorite low-carb Italian food orders, classified by course.

Antipasti (appetizers):

  • Insalata caprese (mozzarella, tomato, basil salad) – if you’re lucky, they’ll use fresh mozzarella di bufala, the most delicious cheese I’ve ever tasted!
  • Verdure grigliate misti (mixed grilled vegetables)
  • Affettato misto or salumi misti (mixed cold cuts)
  • Prosciutto (ham)

Secondi (entrees):

  • Tagliata/bistecca/filetto di manzo (beef)
  • Salsiccia (sausage)
  • Petto di pollo (chicken breast)
  • Vitella (veal)
  • Bollito alla picchiapo (beef stew in tomato sauce)

Contorni (side dishes):

  • Carciofo alla romana (roman artichoke)
  • Peperone (bell peppers)
  • Spinaci (spinach)
  • Insalata (salad)
maria horner

Image source: diaTribe

Maria Horner is a college student from Northern Virginia. She was diagnosed with type 1 diabetes at age seven, but she hasn’t let that hold her back! She had the incredible opportunity to study abroad in Rome during the fall of 2018, and recently started a blog about her experiences, to help and encourage other people with diabetes that are interested in studying abroad. When she’s not in class, you can find her taking a dance course or trying out a new recipe in the kitchen. She also loves travelling and going on adventures, one of her most recent adventures being skydiving!

Source: diabetesdaily.com

Mediterranean Chicken of Love

This content originally appeared on TCOYD: Taking Control of Your Diabetes. Republished with permission.

By Chef Robert Lewis

You will find joy in serving this hearty dish. It’s rich in protein, packed with vegetables, and flavored with herbs.

Mediterranean Chicken of Love

Tender, juicy chicken infused with garlic and herbs is blended with tomatoes and beans for a rich and full-flavored nod to Greek cuisine.

  • 1 tablespoon extra virgin olive oil
  • 1 tablespoon garlic
  • 2 white button mushrooms (large, sliced)
  • ½ red bell pepper (sliced)
  • ½ green bell pepper (sliced)
  • 1 Roma tomato (diced)
  • ½ red onion (sliced)
  • 1/4 cup vegetable broth
  • 5-6 stalks asparagus
  • 1 teaspoon oregano
  • 1 teaspoon rosemary
  • 1 teaspoon basil
  • 1 tablespoon fresh garlic
  • 8 oz skinless chicken (sliced, precooked )
  • 10 black olives (pitted )
  • 1 can white Italian beans (15 oz., drained)
  • black pepper (to taste)
  • ½ fresh lime
  1. Heat oil in a large skillet over medium heat.
  2. Add the mushrooms, bell peppers, onions and asparagus and sauté for 3 minutes.
  3. Add the cooked chicken and garlic.
  4. Lower heat. Add vegetable broth, oregano, rosemary, basil, diced tomatoes, beans, olives, and simmer for about 5 minutes.
  5. Cook over low heat until chicken is nice and hot.
  6. Season with pepper to taste and a squeeze of lime.

Mediterranean Chicken of Love RECIPE

Source: diabetesdaily.com

Was Your Medicare Claim Rejected? Here’s How to Appeal

This content originally appeared on diaTribe. Republished with permission.

By Kara Miecznikowski and Eliza Skoler

Learn how to appeal a Medicare claim rejection under traditional fee-for-service Medicare, a Medicare health plan, or Medicare prescription drug coverage

A health insurance claim is a bill for your healthcare services, medications, or medical equipment that you think should be covered by your insurance plan. If you have Medicare health insurance, your healthcare practitioner will usually submit claims directly to Medicare for payment. If Medicare decides to reject the claim, you can challenge the decision. This is called an appeal.

In the United States, people have the right to appeal a denied claim for up to six months after hearing about this decision. Appeals can often be successful – a 2018 report showed that 75% of Medicare Advantage denials were overturned in the appeals process – which means that challenging a denied claim could save you money. This article will explain how to appeal a Medicare claim rejection.

To learn more about the appeals process in the United States – especially if you have a different health insurance plan – read our article, “When Insurance Gets Turned Down: Appeals Explained.”

How do Medicare appeals work?

You can appeal a decision made by the national Medicare fee-for-service program (Parts A and B), your private Medicare health plan (Part C), or your Medicare Prescription Drug Plan (Part D). Learn more about the different types of Medicare here.

Click to jump down to:

Appeals under Medicare Part A or B (“Original Medicare”)

Appeals under Medicare Part C (Medicare Advantage health plan)

Appeals under Medicare Part D (prescription drug plan)

Here are some common situations for appealing a claim rejection:

  • If you have already received the service, medication, or medical supplies. Example: your doctor gives you lab tests during a visit, but then Medicare rejects the claim.
  • If your doctor requested the service, medication, or medical supplies for you. Example: your doctor says you need an insulin pump and Medicare decides that is not medically necessary.
  • If you and your doctor request a change in price for your medication, based on what treatments work for you. Example: generic drugs do not work for your condition, so your doctor asks for a discount on the more expensive drug.

The appeals process is different under Medicare Part A, B, C, or D. There are five levels to the appeals process. If you disagree with the appeal decision at level one, you can continue to appeal the decision again at every other level.

With each appeals processes, write your Medicare number on every document you submit for your appeal, and keep a copy of all the materials you send in.

Filing an appeal under Medicare Part A (hospital insurance) or Part B (medical insurance), often called “Original Medicare:”

  • Your bill will be sent directly to Medicare.
  • The appeal must be filed within 120 days of receiving the Medicare Summary Notice (MSN) that shows that your claim was denied.
  • If you disagree with a Medicare coverage decision in the MSN, you can appeal the decision.

A Medicare Summary Notice (MSN) is a summary of the health care services you have received over the past three months, sent to you by mail.  It shows what Medicare paid for each service and what you owe for the service, and it will show if Medicare fully or partially denied a medical claim. The MSN also contains your appeal rights and step-by-step directions on when and how to file an appeal for a claim rejection.

Did you sign an Advanced Beneficiary Notice of Noncoverage (ABN) before you received the treatment? An ABN is a notice that your healthcare provider will give you if they think the health services they are recommending might not be covered by Original Medicare. Your ABN will list the items that Medicare is not expected to pay for, as well as the estimated costs of those health services. The ABN can help you decide if you would still like to receive the treatment, and if you will pay for it if Medicare declines to cover the cost.

When you sign an ABN you can ask your healthcare provider to submit the claim to Medicare (before billing you), asking Medicare to cover the cost. If Medicare rejects the claim, you can appeal the decision. If your healthcare provider did not give you an ABN before treatment, you might not be responsible for paying for the health service. Learn more ABNs and appeals here.

There are three different ways to file an initial appeal under Original (Part A or B) Medicare:

appeals

Image source: iStock Photo

  • Fill out a “Redetermination Request Form” with information from your MSN; send the form to the address provided on your MSN
  • Follow instructions on your MSN for filing an appeal without using the form:
  1. Circle the claim that you disagree with on your MSN
  2. On a separate piece of paper, explain why you disagree with the decision
  3. Write your name, address, phone number, and Medicare number on the MSN, and sign it
  4. If you have any other information that will support your case, include it; you can ask your doctor or other health care provider to help you
  5. Send all of the above materials to the address listed under “Appeals Information” on your MSN
  • Or, send a written request to the company that processes Medicare claims. Include:
  1. Your name and Medicare number
  2. The item that you disagree with on the MSN
  3. An explanation of why you disagree with the decision
  4. Your signature
  5. Send all of the above to the address provided under “Appeals Information” on the MSN

You should receive a decision within 60 days of your request, unless you submit extra information after you first file the appeal (which may delay the decision).

For more information on the Original Medicare initial appeals process, see the Medicare webpage. If you disagree with the appeal decision at the first level, you have 180 days to file an appeal at the second level; information on the appeals process beyond level one can be found here.

Filing an appeal under Part C (Medicare Advantage health plans):

  • The initial appeal must be filed within 60 days of receiving the claim rejection.
  • You must send a written request (unless your plan allows you to file a standard request by phone, fax, or email instead).

In your request, include:

  1. Your name, address, and Medicare number
  2. The item you disagree with, the date that you received the service, and an explanation of why you disagree with the decision
  3. Any other information that may support your case

You should receive a decision about your appeal within 60 days, unless Medicare needs more time to obtain information from your healthcare provider. If waiting for a decision will hurt your health, your appeal decision will be made within seven days.

If your appeal is rejected (fully or partially), your request will automatically be sent to level two of the appeals process. More information on the initial appeals process under Medicare Part C can be found here. For information on the process after level one, click here.

Filing an exception request or appeal under Medicare Part D (prescription drug plans):

  • Reasons to request an exception to your Part D drug plan:
    • If your plan decides not to provide a medication you think should be covered.
    • If cheaper versions of your medication don’t work for you, you can ask for a discount on the more expensive medication.
    • If a drug you need is not on your plan’s drug list, you can ask for an exception.
  • An exception request must be submitted first; if your exception request is denied, you have 60 days to appeal the prescription drug claim rejection.
  • You must send a written request (unless your plan allows you to file it in another way).

An “Evidence of Coverage” document explains your rights with your Medicare prescription drug plan. You have the right to ask your plan to pay for a medication you think should be covered, and you have the right to request an appeal if you disagree with your plan’s decision to provide it.

appeals

Image source: iStock Photo

Before appealing a claim rejection, you will request an exception:

  1. Fill out a Medicare Prescription Drug Coverage Determination request form through your insurance plan sponsor
  2. Ask the healthcare provider who prescribed your medication to write a letter explaining why you need this medication
  3. Send the documents to your Medicare health plan

You should hear back about your request within 72 hours. If your exception is denied, you can appeal the claim rejection. To submit a written appeals request, include:

  1. Your name, address, and Medicare number
  2. The drug you want your plan to cover
  3. An explanation of why you are appealing the coverage decision.
  4. Any other information that may support your case, including medical records
  5. Send the documents to your Medicare health plan

You should receive a decision within seven days. If waiting for a decision will hurt your health, your appeal decision will be made within 72 hours.

More information on the initial prescription drug appeals process can be found here. If your request is not met (fully or partially), you have 60 days to appeal the decision at the next level; learn about further appeals here.

How can I get help filing an appeal?

You can have someone else file an appeal for you. This can be a family member, friend, lawyer, doctor, or anyone else that has agreed to be your representative. For more information and the representative form, see the Medicare website page on how to appoint a representative. For prescription drug appeals, your doctor or prescriber can request an initial appeal for you; you do not need to first fill out a form.

For more help with appeals, especially appeals beyond level one, contact your State Health Insurance Assistance Program (SHIP). SHIP is a network of free counseling services that help people navigate Medicare; find the SHIP program in your state here.

diaTribe Series

Image source: diaTribe

This article is part of a series on access that was made possible by support from AstraZeneca. The diaTribe Foundation retains strict editorial independence for all content. 

Source: diabetesdaily.com

Food Shaming: Changing How We Talk About Food

This content originally appeared here. Republished with permission.

By Brenda Manzanarez, MS, RD, and Cynthia Muñoz, Ph.D., MPH

You know you shouldn’t be eating that kind of stuff, right?

If you’d just eat better, you wouldn’t have to take so many medications.

I know someone who cut out all carbs and cured their diabetes; have you tried that?

Do any of these comments sound familiar? Maybe someone else has said them to you, maybe you’ve said them to someone, or maybe you’ve thought them about yourself. Either way, comments like this, even if they have good intentions, often come off as judgmental and shaming. This type of “advice” can cause confusion, anxiety, frustration, and an unhealthy relationship with food.

Our Relationship with Food

Food is important when it comes to keeping blood sugar in range, but managing diabetes is not just about glycemic control—we also need to juggle lifestyles, health goals, and mental health.

There are so many factors that influence our food choices, and you cannot see those factors by just glancing at a plate. Food is an important part of our lives, and it can have so many meanings to different people. It can mean health, love, sense of community, or pleasure, but for others, especially people with diabetes, it might cause feelings of anxiety and fear.

Changing the way you eat is a major lifestyle change, and major lifestyle changes always take time.

While you are on this journey, unsolicited advice from strangers and even loved ones can feel more like judgment and might cause you to question yourself or feel guilty about your own choices.

Changing the way you eat is a major lifestyle change, and major lifestyle changes always take time. There are a lot of things to juggle when managing diabetes, so be patient with yourself and with others.

Unintended Consequences

Food shaming often happens when someone’s own preferences and opinions don’t line up with others’. Judgmental comments like “you shouldn’t eat that” may be a projection of their own frustrations or a reflection of their misconceptions about diabetes.

As clinicians who work with children, teens, and young adults with diabetes and obesity, we know that talking about food can be very difficult. We also know that negative comments, pictures, and memes on social media can have a harmful impact on someone’s emotional well-being, especially people with diabetes.

No one should be shamed about their food choices.

No one should be shamed about their food choices. Shame leads to negative feelings about food, which can lead to anxiety, depression, and even disordered eating. And these conditions can cause more damage to physical health than poor diet.

Rethink the Role of Food and Your Health

Instead of thinking of food as “good” or “bad,” or judging people (or yourself) by the way you eat, picture food and eating as being neutral and adopt a non-judgmental way of thinking. The food you put on your plate, is just food that will provide energy and nutrients to fuel your body.

Unlearning what we have been exposed to takes time but being aware of those negative thoughts is a start.

Instead of thinking of food as “good” or “bad,” picture food and eating as being neutral.

Remind yourself that there is no one right way to eat with diabetes— it has to be tailored to your own unique needs— like your budget, taste preferences/favorite foods, cultural norms, cooking skill, time, etc. And you don’t have to feel guilty about enjoying a treat every now and then.

Break the cycle and be nice to yourself and to others. Instead of criticizing people, ask them how they feel about the changes they’ve made and have them decide how they feel about it. If appropriate, provide encouragement.

If you are concerned about a loved one, privately ask how they are doing, and don’t offer advice unless they ask for it. Ask if there is anything you can do to support them, and/or seek information about healthy food choices and incorporate this in your own life as a form of support for your loved one.

If you feel this is a big issue in your own life, don’t be afraid to seek out help—talk to your primary doctor or with a therapist. If you don’t have a therapist ask for a referral from your doctor. To find a mental health provider with knowledge about diabetes, check this directory.

Bottom Line

Food is meant to be nourishment for our bodies and to be enjoyed; find a balance that works for your health, be confident in your choices, and be accepting of other people’s choices.

If you find yourself wanting to criticize someone else’s food choices or appearance, don’t! This is generally not helpful and can have a negative emotional impact.

A neutral and non-judgmental way of thinking is best when talking about food and diabetes; there are no “good” and “bad” foods. The key is to balance what you eat to get the nutrients you need.

If you receive a negative comment from a stranger on social media or in person, remember that person doesn’t know you and how you take care of yourself. Don’t beat yourself up and continue to focus on ways to be the healthiest version of yourself.

Source: diabetesdaily.com

Sun-Dried Tomato Marinara

This content originally appeared on ForGoodMeasure. Republished with permission.

Raw food followers believe heat kills food’s nutrients & natural enzymes. For those of us who like high temperatures, cooking changes a lot of things, most significantly … flavor. This sauce is no exception. A classic marinara with the combination of tomatoes, onion, garlic, and herbs, however, the addition of sun-dried tomatoes and lack of heat, elevate the intensity to something altogether unexpected.

Sun-Dried Tomato Marinara

This recipe works great as sauce for your homemade pizza, poured over zucchini linguini or as an accompaniment to your morning fried eggs.

  • 4 cups tomatoes (chopped)
  • 1 cup sun-dried tomatoes (drained if in oil)
  • 1 cup basil
  • ½ cup parsley (chopped)
  • ¼ cup red onion (chopped)
  • 2 tablespoons olive oil
  • 2 teaspoons garlic (minced)
  • 1 teaspoon apple cider vinegar
  • 1 teaspoon chili flakes
  • 1 teaspoon maple syrup
  • 1 teaspoon oregano
  • ½ teaspoon salt
  • ¼ teaspoon pepper
  1. Using the processor, combine tomatoes, sun-dried tomatoes, basil, parsley, onion, olive oil, garlic, vinegar, chili flakes, syrup, oregano, salt and pepper, until thick and creamy.

Naturally low-carb and gluten-free.

Net carbs: 6g

Sun-Dried Tomato Marinara Recipe

Source: diabetesdaily.com

My Dos and Don’ts for People Without Diabetes

This content originally appeared on Beyond Type 1. Republished with permission.

By Erika Szumel

Managing type 1 diabetes (T1D) means insulin calculations, getting plenty of exercise, and making strategic meal plans. But it also means awkward moments, unnecessary advice, and lots of looks from people who don’t live with diabetes.

While we might be well-equipped to take care of our disease, we aren’t always ready for these awkward moments with strangers, friends, and family who might not understand what we live with.

Here are the dos and don’ts of diabetes etiquette for those without diabetes, written by a T1D.

Do Ask Questions.

If you’re speaking to someone with type 1 diabetes, ask questions about the condition. I believe that 9 times out of 10, when the question is asked kindly, that the T1D will be happy to answer you. At the end of the day, we’d rather you understand better than continue to walk around with misconceptions.

Don’t Ask Loaded Questions.

Is it the bad type?
So you just have to watch your diet, right?
Did you eat too much sugar as a kid?

When people with T1D hear questions like this, it can be enlightening and frustrating at the same time. Enlightening because I am surprised to hear people still make these assumptions or have these ideas. Frustrating because these people still make these assumptions or have these ideas. Try phrasing a question like, “Can I ask you something so I understand type 1 more clearly?” or “Do you mind telling me more about it?”

Do Be Supportive.

What does being supportive really mean to you? For someone with type 1 Diabetes, it’s nice to know that others sort of understand what’s going on and that they are willing to help if needed. This could simply mean checking in on your friend or helping them find a snack when they are low. Showing your support displays itself in various ways.

Don’t Tell Us Horror Stories About Your Relatives.

The general public tends to have the idea that telling someone with T1D about your grandfather who lost his foot because of diabetes is, I don’t know, helpful? Most patients diagnosed with T1D are aware of the possibility of complications and their effects on the body caused by T1D. Please do not feel like it is your duty to remind us of the things that can happen to us (or may have already started) when you don’t know! Bring this into the conversation if the person with T1D has started talking about it or asks you a question.

Do Help Us Be Prepared for Lows.

Whether you’re a spouse, friend, or coworker, helping us be prepared for lows is such a kind gesture. That simply means knowing where snacks or low treatments are in the home or office and helping us get them when we need them.

Don’t Shrug Us off Simply Because What’s Happening Is Invisible.

Type 1 diabetes is an autoimmune disease that can have some serious consequences. The scary part: it’s mostly invisible. Other than my insulin pump and continuous glucose monitor (CGM) and their respective sites, you cannot tell that people with T1D are any different than you – with the exception of seeing us test our blood sugar or give a manual injection with a syringe or insulin pen.

I think one of the worst feelings I encounter having this condition is feeling like it means nothing to those around me – and this is usually solely because of ignorance or lack of understanding. Please don’t shrug it off as the “take insulin, watch what you eat” disease, because it is so much more complex. Be mindful of those with T1D, and be willing to offer a helping hand if they need something.

Do Help Us Stop the Stigma.

If you’ve been around a T1D for some time and have learned enough about it, then help us stop the stigma. When you hear comments or jokes about it, do your best to raise awareness for what is true about this condition.

Don’t Ignore the Jokes.

I think a huge part of raising awareness for type 1 diabetes is simply stopping jokes and memes dead in their tracks. I think people will remember when you stop them in that moment and say “Hey, that actually isn’t how it works” or “It’s actually a lot more serious than that.”

At the end of the day, there are a few things you should and shouldn’t do as a good friend, partner, or stranger to the millions of people affected worldwide by type 1 diabetes. Hopefully, this list will help you do just that.

Source: diabetesdaily.com

Advancements in Treatment: The Use of Adjunctive Therapies in Type 1 Diabetes

This content originally appeared on diaTribe. Republished with permission.

By Paresh Dandona and Megan Johnson

Read on to learn about the research around GLP-1, SGLT-2, and combination therapy use in type 1 diabetes. Dr. Paresh Dandona is a Distinguished Professor and Chief of Endocrinology at the University of Buffalo, and Megan Johnson is a fellow on his team

For people living with type 1 diabetes, new treatments are finally on the horizon. The University at Buffalo (UB) Endocrinology Research Center is helping to revolutionize the treatment of this condition. Among the most promising new therapies are two non-insulin medications currently used in type 2 diabetes, SGLT-2 inhibitors and GLP-1 receptor agonists.

SGLT-2 inhibitors, such as Farxiga, act the kidney to help the body excrete more glucose in the urine. Meanwhile, GLP-1 receptor agonists like Victoza work in several different ways: increasing the body’s natural insulin production, decreasing the release of the glucose-raising hormone glucagon, slowing the emptying of the stomach, and curbing excess appetite. Some people with type 1 diabetes take these medications as an addition to insulin treatment as an “off-label” drug. To learn more about off-label, check out the article: Can “Off Label” Drugs and Technology Help You? Ask Your Doctor.

Why consider these medications?

In people without diabetes, the body is constantly releasing more or less insulin to match the body’s energy needs.  People with type 1 diabetes do not make enough insulin on their own and have to try to mimic this process by taking insulin replacement – but it isn’t easy.

People with type 1 diabetes often have fluctuations in their blood sugars, putting them at risk for both low blood sugars (hypoglycemia) and high blood sugars (hyperglycemia). Many individuals are unable to manage their blood sugars in a healthy glucose range with insulin alone. In fact, less than 30% of people with type 1 diabetes currently have an A1C at the target of less than 7%.

Can GLP-1 agonists be safely used in type 1 diabetes?

Over the past decade, the endocrinologists at the University at Buffalo and other research groups have been conducting studies to see whether GLP-1-receptor agonists can safely be used in type 1 diabetes.

  • The first of these was published in 2011 and showed a decrease in A1C within just four weeks of GLP-1 agonist treatment. Importantly, people given GLP-1 agonists plus insulin also had much less variation in their blood sugars, as measured by continuous glucose monitors (CGM).
  • Another study involved 72 people with type 1 diabetes who took GLP-1 agonist or placebo (a “nothing” pil) in addition to insulin for 12 weeks. The GLP-1 group had decreases in A1C, insulin requirements, blood sugar fluctuations, and body weight. People in this group did report more nausea – a common side effect of GLP-1 agonists.
  • Since then, multiple studies, some involving over 1000 people and lasting up to 52 weeks, have shown that GLP-1 treatment in people with type 1 diabetes can reduce A1C and body weight, along with insulin dosages.

Many of these studies, but not all, have suggested that GLP-1 agonists can do this without increasing the risk for hypoglycemia or diabetic ketoacidosis (DKA). There is also some evidence that GLP-1 agonists can improve quality of life in type 1 diabetes.

Who should consider GLP-1’s?

The effects of GLP-1 agonists seem to be especially strong in individuals who are still able to make some insulin on their own, although it also works in people who do not.

In one notable study, researchers gave a GLP-1 agonist to 11 people with type 1 diabetes who were still able to produce some insulin. To get an estimate of insulin production, they measured levels of a molecule called C-peptide, which is produced at the same time as insulin. In these 11 individuals, C-peptide concentrations increased after GLP-1 treatment. By the 12-week mark, they had decreased their insulin dosage by over 60%. Incredibly, five people were not requiring any insulin at all. Even though the study was very small, the results were exciting, because it was the first study to suggest that some people with type 1 diabetes had sufficient insulin reserve and thus, could – at least temporarily – be treated without insulin.

Can SGLT-2 inhibitors be used in type 1 diabetes?

SGLT-2 inhibitors like Farxiga have also shown tremendous potential. In two large studies called DEPICT-1 and DEPICT-2, adults with type 1 diabetes were randomly assigned to take either placebo or SGLT-2 inhibitor in combination with insulin. Over 700 people from 17 different countries participated in DEPICT-1, and over 800 people with type 1 diabetes participated in DEPICT-2. At the end of 24 weeks, people taking dapaglifozin had a percent A1C that was lower, on average, by 0.4 compared to people who had received placebo, and it was still lower, by over 0.3, at 52 weeks. The number of hypoglycemic events was similar in both groups.

As with GLP-1 agonists, people taking SGLT-2 inhibitors had weight loss and decreased insulin requirements. People taking SGLT-2 inhibitor, however, did have an increased risk of diabetic ketoacidosis (DKA). If individuals consider this therapy, they should be cautious about not missing meals or insulin, and not drinking large amounts of alcohol, as these behaviors can lead to increased ketone production.

Several other research groups, in trials recruiting up to 1000 individuals, have seen similar results when using this class of medications.  Researchers have been conducting additional studies to try to determine how best to minimize the risks associated with them. Farxiga (called Forxiga in Europe) has now been approved as the first oral agent as an adjunct treatment for type 1 diabetes in Europe and Japan.

Promising Combination Therapy

Now, endocrinologists are also looking at whether GLP-1 agonist and SGLT-2 inhibitor combination therapy could increase the benefits of each of these treatments. A study conducted on a small number of people showed that GLP-1 agonists can help prevent ketone production, so it is theoretically possible that this medication could reduce the risk of DKA that was seen with SGLT-2 inhibitors.

In an early study involving 30 people with type 1 diabetes who were already on GLP-agonist and insulin were randomly assigned to take SGLT-2 inhibitor or placebo, as well. People who received both drugs saw an 0.7% reduction in A1C values after 12 weeks, without any additional hypoglycemia. People on the SGLT-2 inhibitor did make more ketones, though, and two individuals in the combination group experienced DKA. Larger studies are now being conducted to expand on these results and learn more about how to give these drugs safely. The hope is that non-insulin therapies will soon be approved for type 1 diabetes. By unlocking the potential of these therapies, we can do more than manage blood glucose levels – we can improve people’s lives.

Source: diabetesdaily.com

Low-Carb Keto Italian Lemon Cream Cake

This content originally appeared on Sugar-Free Mom. Republished with permission.

Have you ever wondered what the difference is between an Italian Cream Cake and an Italian Lemon Cream Cake? I’m an Italian American born in the States and my father is from Sicily. He and I both, and my mother, an Italian American, have never heard of or tried an Italian Cream Cake. My Nonna, my father’s mother, born and raised in Italy all her life, never once made an Italian Cream Cake. How it got the name Italian in front of this cake, we shall never know.

The origin of an Italian Cream Cake seems to be from the Southern American states. It starts with a yellow cake mix, buttermilk and also includes pecans and coconut. As I said, my father, nonna, mother and I have never seen it when in Italy or have tried it so it wasn’t on my top foodie list to recreate a keto version. But this Italian Lemon Cream Cake I’m sharing today was my birthday cake a few months ago and it did not disappoint my Italian family!

An Italian Lemon Cream Cake has no resemblance to the Southern Italian cream cake, except for the fact you have a yellow cake as the base. When my parents would take us to Olive Garden, they discovered this Italian Lemon Cream Cake and then for every holiday or family party, would purchase one to enjoy together. The origin of this Italian Lemon Cream Cake is also not one found in Italy, but with a lemon mascarpone filling, lemon-flavored yellow cake and butter crumb topping, this is more Italian than any other version you’ll try.

Keto Nut-Free Italian Lemon Cream Cake

This Low-Carb Keto Italian Lemon Cream Cake is nut-free, gluten-free, and perfect for any celebration with your family and friends.

Cake

  • 1 cup coconut flour
  • 1/2 cup Swerve confectioners
  • 1 tsp baking soda
  • 1 tsp baking powder
  • 1/4 tsp salt
  • 1 tsp glucomannan ( or xanthan gum)
  • 1/2 cup sour cream
  • 1/2 cup butter softened
  • 1/2 cup heavy cream
  • 1 tsp lemon extract
  • 1/2 tsp lemon liquid stevia
  • 6 large eggs

Filling

  • 8 ounces mascarpone cheese or cream cheese (softened)
  • 1/2 cup Swerve confectioners
  • 1/2 tsp lemon zest
  • 1 tbsp lemon juice
  • 1 cup heavy cream

Butter Crumb Topping

  • 1/2 cup coconut flour
  • 1 tsp lemon juice
  • 1/3 cup Swerve confectioners
  • 1/4 tsp vanilla liquid stevia
  • 1 stick butter cold (cut into pieces or 1/2 cup)

Cake

  1. Preheat oven to 350 degrees F. Grease two 9 inch springform pans and set aside.

  2. Whisk together coconut flour, Swerve, baking soda, powder, salt and glucomannan or xanthan gum. Set aside.
  3. To a stand mixer or use an electric hand mixer, add the sour cream, softened butter, heavy cream, lemon extract, and stevia and blend until combined. Add one egg at a time until combined. Pour in half the dry ingredients and blend until well combined. Add remaining dry ingredients until nicely incorporated.

  4. Pour cake batter evenly into each cake pan. Bake for 25 -30 minutes or until a toothpick in center comes out clean. Allow to cool 5 minutes then use a butter knife to loosen all around the edges of the cake. Allow to cool completely before removing the sides of the springform pan.

Filling

  1. Place all the ingredients, except the heavy cream, into a clean bowl or stand mixer and blend until smooth using the paddle attachment. Taste and adjust sweetener if needed. Pour in the heavy cream with the whisk attachment, whisk on medium-high until nice and smooth and thickened. Set aside in the refrigerator until the cake is cooked and cooled.

Butter Crumb Topping

  1. Place the dry ingredients into a food processor and process to combine. Add in cold butter. Pulse until crumbs form. Do not over process. Set aside.

Assemble

  1. Place one cake layer on your serving plate. Spread about 3/4 of the filling onto the cake, saving 1/4 of filling for the top layer. Place the second cake layer over the filling. Spread the remaining filling over the top. Carefully using your hands, sprinkle over the crumb topping over the top of the cake and sides, pushing lightly into the cake. Keep refrigerated until ready to serve.

Net carbs: 4g

Low-Carb Keto Italian Lemon Cream Cake Recipe

Source: diabetesdaily.com

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